UNILATERAL SLING TRANSECTION RELEASES OBSTRUCTION AND PRESERVES CONTINENCE IN PATIENTS WITH POST-OPERATIVE VOIDING DYSFUNCTION AFTER TRANS-OBTURATOR SLING SURGERY

Daniela Biferi1; Vikiela Galica1; Daniele Castellani1; Pietro Saldutto1;  Giovanni Giovanditti1; Cristian Cicconetti1; Giuseppe Paradiso Galatioto1; Carlo Vicentini.
1 Department of Health Science, University of L'Aquila, Teramo Hospital, Italy

Topic: Urinary incontinence surgery.
Abstract                                                                                                                                 
Objective. The objective of this study was to assess the outcome of unilateral sling release in patients with bladder outlet obstruction (BOO) after trans-obturator-tape (TOT) positioning for genuine stress urinary incontinence (SUI).                                                                                                        
Materials and Methods. Between January 2005 and June 2013 one-hundred-twelve women underwent TOT procedure for genuine SUI using Monarc® sub-fascial hammock, adjusted in a tension-free manner. Patients suffering persistent BOO underwent unilateral sling release within 6 weeks. They were followed prospectively at 1-week, at 6-weeks, at 6-months and then yearly with physical examination, cough stress-test, urine culture, uroflowmetry and ultrasound PVR measurement and urodynamics. Lower urinary tract symptoms (LUTS) were assessed with the American Urological Association Symptom Index (AUASI).                                                                               
Results. Nine consecutive women had unilateral sling release showing relief of BOO, symptoms and urodynamics parameters improvement. The procedure required few minutes in local anesthesia and no complications occurred. The results  were persistent during follow-up and 88,9% of the women were still continent.                                                                                                                      
Conclusion. This study shows that unilateral transection of the sling after TOT in women with BOO is both effective, in treating voiding dysfunction and preserving continence.
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